【摘要】 目的探讨四孔法完全腹腔镜下完成全直肠系膜切除(total mesorectal excision,TME)、直肠拖出低位或超低位行结肠-直肠、结肠-肛管吻合治疗直肠癌的可行性。方法2008年4月~2009年5月,按TME原则,四孔法完全腹腔镜下对29例低位直肠癌实施低位或超低位结肠-直肠、结肠-肛管吻合术,全系膜游离后拖出肛门外切除并手工吻合或吻合器吻合。结果29例均完全在腹腔镜下完成,无辅助切口,保肛率100%。手术时间150~310min,平均185min。术中出血20~120ml,平均50ml。术后2~3d恢复胃肠功能并下床活动,住院时间12~35d,平均15d。术后28例应用止痛剂。1例直肠阴道瘘。29例随访3~13个月,平均8个月,未发现穿刺口种植和局部复发。结论四孔法完全腹腔镜下行TME低位或超低位结肠-直肠、结肠-肛管吻合术治疗直肠癌安全可行,具有创伤小、出血少、保肛率高、术后疼痛轻、恢复快等优点。更多还原

【Abstract】 Objective To study the feasibility of total laparoscopic operation with four trocars to complete total mesorectal excision(TME),low or ultra low colorectal anastomosis,and colo-anal anastomosis for the treatment of rectal carcinoma.MethodsFrom April 2008 to May 2009,according to the principles of TME,four trocars were used to perform total laparoscopic operation on 29 cases of low rectal carcinoma from April 2008 to May 2009.Low or ultra low colorectal anastomosis and colo-anal anastomosis were carried out during the operation.The anastomosis was made artificially or mechanically after the total mesorectum being pulled out of the anus and resected.Results Laparoscopic operation was completed in all of the patients without assisted incision being made.The rate of anus preservation was 100% in this series.The operation time ranged from 150 to 300 minutes with a mean of 185 minutes,during which 20-120 ml blood loss were detected(mean,50 ml).After the treatment,the gastrointestinal function and daily activities of the patients recovered in two or three days;28 of the patients received anodyne postoperation.One patient developed rectovaginal fistula after the surgery.The mean hospital stay was 15 days(ranged from 12 to 35 days).Twenty-nine patients were followed up for a mean of eight months(ranged from 3 to 13 months)after being discharged;during the period,no local recurrence or implantation at the puncture site was detected.Conclusions Laparoscopic TME and radical rectectomy are safe and feasible for patients with rectal cancer.The procedure is minimally invasive and leads to little blood loss,high rate of anus preservation,mild postoperative pain,and quick recovery.更多还原